The proposed project will address important public health questions, highly relevant to the mission of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about stroke burden and stroke-related clinical outcomes in patients with advanced chronic kidney disease (i.e., CKD stages 4 and 5) and with dialysis-requiring end stage renal disease (ESRD). Worldwide, several million patients have CKD 4-5 and dialysis-requiring ESRD, a number which is expected to grow substantially in coming decades. Stroke is common in such patients, but many stroke-related questions remain unexplored. The aims of the proposed project are to (1) determine how stroke rates change as kidney disease worsens; (2) create a dynamic risk calculator to quantify the competing risks of death, recurrent stroke, and survival on dialysis following a stroke; (3) quantify the post-stroke clinical course by determining rates of discharge to home versus to a skilled nursing facility afte a stroke, rates of 30- and 90-day all-cause hospital readmissions after stroke, and the factors associated with these outcomes; and (4) explore how electronic heart rhythm-monitoring devices are currently used for the detection of arrhythmias in order to improve primary stroke prevention in CKD patients. The work will be accomplished by creating large, retrospective cohorts of CKD and dialysis patients via use of comprehensive administrative databases provided by the United States Renal Data System and the Centers for Medicare and Medicaid Services. Multivariable and competing-risk statistical techniques will be used to model relationships between various risk factors and clinically- important outcomes, permitting clinical inferences to be made and generating key information which can be used to inform conversations between patients and physicians about the implications of stroke on patient health status.